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Ophthalmology & Optometry Coding Alert

Cataract Mythbuster:
Yes You Can Collect More Money for Complex Pediatric Cataract Extractions
Determining what your insurers consider “complex” is key. Your practice pr... Read more
Revenue Booster:
Don't Know Your Lateral From Your Inferior Rectus Muscles? Strabismus Pay Might Elude You
Nail down your anatomic knowledge now and collect appropriately later. Orthopedic code... Read more
Patient Privacy:
Don't Let a Text Compromise Your Eye Practice's Security
HIPAA-compliant messaging helps practices maintain their patients’ privacy. You... Read more
Reader Question:
Know the IOL Rules
Question: A patient undergoing complex cataract surgery received an astigmatism-cor... Read more
Reader Question:
Consider Type of Telemedicine When Choosing Code
Question: Often, one of our ophthalmologists or qualified nonphysician practitioner... Read more
Reader Question:
Determine Conjunctivitis Details Before Selecting Code
Question: We reported H10.10 for a conjunctivitis case – which is what we&rsq... Read more
You Be the Coder:
Know When, How to Amend Notes
Question: Our office performed an audit prior to submitting our claim to insurance ... Read more
CPT® 2017:
Latest CPT® Edition Updates Retinal Repair Codes
You’ll also see changes to angiography reporting. Although it’s still Octo... Read more
Documentation:
CMS Finds Rampant Errors Among Blepharoplasty Claims
No visual field testing? No Medicare payment, latest compliance newsletter says. You m... Read more
Patient Privacy:
HHS Targets Small HIPAA Breaches for Increased Scrutiny
New focus could impact eye care practices that aren’t part of big health systems. ... Read more
Clip And Save:
Check This List to Ensure You're HIPAA-Compliant
As technology evolves, so should your HIPAA plan. When you first created your practice&r... Read more
Reader Question:
Know When Procedure Is 'Staged'
Question: We performed a retinal detachment repair on a patient, and the following ... Read more
Reader Question:
Know the Modifier 55 Rules
Question: Our ophthalmologist is seeing a patient for follow-up visits after anothe... Read more
You Be the Coder:
ABNs Can Protect You
Question: We haven’t customarily used advance beneficiary notices (ABNs) in o... Read more
Ask The Expert:
Use These Expert Answers to Code Your Next Retinal Surgery Chart
Can you accurately code retinal detachments? Read more to find out. When you look thro... Read more
E/M Services:
Can You Code This E/M Note?
Ensure that you aren’t making a $31 mistake in your ophthalmology charts. Would ... Read more
Medicare Isn't the Only Payer Scrutinizing Claims
Medicaid is also checking your coding prowess. The Medicare CERT report reveals the mo... Read more
ICD-10:
Look to 6th Digit for Most Hypotony Diagnoses
Cause of condition may ease your code selection woes. When your ophthalmologist sees a... Read more
Reader Question:
Look to Modifier 25 When Global Spans 10 Days
Question: When treating a new or established patient and then deciding to do a... Read more
Reader Question:
Will 'X' Mark the Spot for Claims Approvals?
Question: We had a patient present who fell from a ladder and hurt his eye. We were... Read more
Reader Question:
Strabismus Codes Are Unilateral
Question: Our ophthalmologist resected the lateral rectus muscles of both the patie... Read more
You Be the Coder:
Admit Code Will Elude You
Question: Our ophthalmologist admitted a patient to the hospital and asked the code... Read more
Compliance:
5 Co-Management Challenges You Should Know
Co-management is not, and should not be, an agreement to refer, experts say. From a pr... Read more
Modifier 25:
Medicare Could Make Modifier 25 Pay Difficult With These Eye Procedures
  Fee Schedule proposal aims to revalue certain services when billed with modifie... Read more
HIPAA Compliance:
iPhone Breach Leads to Six Figure Settlement
Make sure your practice’s business associates stay on the right side of the law. ... Read more
Reader Question:
Corneal Repair Trumps Foreign Body Removal
Question: Our ophthalmologist removing a corneal foreign body, and then performed a... Read more
Reader Question:
Know When Time Is on Your Side
Question: Our ophthalmologist often spends nearly an hour speaking with patients wh... Read more
You Be the Coder:
Doctor Should Take Lead When Managing Annual Vision Benefit
Question: Our patient’s vision plan covers either contacts or glasses annuall... Read more
Correct Coding Initiative:
New CCI Edits Restrict Visual Screenings With E/Ms
Fortunately, you can use a modifier to separate the edits when warranted. Although mos... Read more
Revenue Builder:
Follow This Practice Administrator's Lead to Collect More of Your Fees
Hint: Requesting self-pay amounts before surgery makes all the difference. Chasing dow... Read more
ICD-10:
Let 'Z' Codes Support Your Ophthalmology Claims and Help Bring in Payments
These codes aren’t just to make your claims lengthier—they serve an importan... Read more
These Z Codes Can Make Your Claims Shine
Eye care practices that are unfamiliar with additional Z codes beyond the ones mentioned... Read more
Reader Question:
Modifier 24 Shouldn't Change Dx Choice
Question: Can you use modifier 24 when the surgery and the E/M with 24 have the sam... Read more
Reader Question:
Locum Tenens Physicians Have Time Limits
Question: We are planning to hire a locum tenens (LT) physician for an ophthalmolog... Read more
Reader Question:
OR-Treated Complication Leads to Modifier 78
Question: A patient returned to the operating room to treat a complication within t... Read more
You Be the Coder:
Look to Documentation for Diagnosis Code
Question: How can I find an acceptable diagnosis code for 76514 (Ophthalmic ultraso... Read more
Coding And Billing Trends:
5 Tips Help You Benchmark Your Way to Better Revenue
If you aren’t evaluating your ophthalmology practice’s trends, you won&rsquo... Read more
Clip And Save:
Here's Your Breakdown of Which Codes Ophthalmologists Are Reporting Nationally
Once you compare your practice’s benchmarking data over time, you may want to take... Read more
Check This Optometry Benchmarking Information
If your eye care practice employs optometrists, you should separately perform a benchmar... Read more
Revenue Builder:
Tackle Your Ophthalmology Practice Challenges With 3 Simple Tips
Positive reimbursement starts with effective communication, these experts say. Ar... Read more
ICD-10:
Forgetting Stage on Glaucoma Claims Could Cost You
Stay on top of the extended descriptors to ensure you can collect for your services. Y... Read more
Reader Question:
Modifier TC Is Your Friend for Split Visual Field Service
Question: A patient came to our practice for a visual field test. He didn’t s... Read more
Reader Question:
Not All NP Services Require Modifier SA
Question: Our ophthalmology practice employs a nurse practitioner (NP), and when sh... Read more
You Be the Coder:
Documentation Will Reveal Whether E/M Is OK
Question: Our ophthalmologist removed a foreign body from a patient’s eye. Ca... Read more
Contact Lenses:
Keep Lens Coding Focused by Avoiding These Myths
Cosmetic or medically necessary? Not all lens codes are created equal. Even in the mos... Read more
Modifiers:
Make the Code Fit the Procedure With Smart Modifier Use
But be careful: Know which eye modifiers have the power to affect your payments. Even... Read more
Practice Management:
Keep an Eye on Your Claims to Max Out Your Ophthalmologists' Pay
Keep your AR up-to-date with claim monitoring. You’re up-to-date on coding chang... Read more
Reader Question:
Amount of Material, Method Determine Vitrectomy Code Choice
Question: Our ophthalmologist performed a pars plana vitrectomy, removing lens frag... Read more
Reader Question:
Work This Plan for SNF Office Payments
Question: One of our ophthalmologists is treating a skilled nursing facility (SNF) ... Read more
Reader Question:
Recognize Breach Under HIPAA
Question: An employee at our ophthalmology practice accessed records for which he h... Read more
You Be the Coder:
Astigmatic Contacts
Question: Which code should we use for monthly replacement toric contacts? We have ... Read more
Cataract Surgery:
Keep Your Cataract Coding Solid With These Expert Tips
Documentation is key – and stay away from the “unspecified” codes. W... Read more
ICD-10:
Expanded Dx Codes Are Coming for Diabetes With Ophthalmic Complications
Also, look for new retinal vein occlusion, AMD, glaucoma, and amblyopia options. New a... Read more
Reader Question:
Look to 66986 for IOL Exchange
Question: The patient presents with a dislocated intraocular lens (IOL), which cann... Read more
Reader Question:
Make Sure Patients Understand EOB's Purpose
Question: We often get patients who call the practice with questions about their ex... Read more
You Be the Coder:
Second Retinal Repair
Question: A patient underwent a retinal repair in the right eye, then three weeks l... Read more
Glaucoma Coding:
Part II: Zoom In on Glaucoma Screening, Testing, Treatment Rules
Do you know which codes should only be used with Medicare patients? Last issue, we bro... Read more
Coding Quiz:
Keep Your Strabismus Coding Straight
Tip: It helps to know the anatomy of the extraocular muscles. How well do you know you... Read more
CCI Update:
CCI Lays Down the Law on IV Codes
CPT® 96361, 96366, 96367, 96368 bundles effect codes in virtually all specialties. ... Read more
Coding Quiz Answers:
Keep Unilateral Rules Straight for Strabismus Success
Two muscles in one eye does not equal one muscle in both eyes. So how did you do with ... Read more
Reader Question:
Determine If Bleph Procedures Are Cosmetic
Question: When our ophthalmologist performs blepharoplasty, I’m often not sur... Read more
Reader Question:
Foreign Body Sensation - But No Foreign Body?
Question: What is proper diagnosis coding if a patient comes in with a foreign-body... Read more
Reader Question:
Stick With Single Dx Code for Diabetic Retinopathy
Question: For a diagnosis of diabetic retinopathy with ICD-10 codes, do we still ha... Read more
Reader Question:
Correct EHR Entries As You Would Paper
Question: We are aware of how to correct a mistake on a paper medical record, but h... Read more
You Be the Coder:
Silicon Oil Removal Dx
Question: What ICD-10 code should I report for silicon oil removal? New Mexico Su... Read more
Glaucoma Coding:
Part I: Get Familiar With All the Angles to Focus Your Glaucoma Dx Coding
Understand who’s at risk, know the screening rules, and specify which eye is affec... Read more
Diagnostics:
Safeguard $80 Each Time by Knowing Fundus Photo Rules
There may be just one CPT® code, but diagnosis coding and bilateral rules could be p... Read more
Place of Service:
Use New POS Code for "Off-Campus" Services
Look for changes in payment coming soon for off-campus provider-based clinics. If your... Read more
Reader Question:
Medicare Won't Pay? Get ABN Anyway
Question: Are patients undergoing keratoconus workup or contact lens fitting still ... Read more
Reader Question:
Don't Try Low-Vision Codes on Medicare
Question: Our practice is considering dispensing low-vision aids. How should we cod... Read more
Reader Question:
Use Split Visit Rules to Duck 15 Percent Pay Cut
Question: I’ve heard nurse practitioners (NPs) and other providers talk about... Read more
You Be the Coder:
Non-Serial Tonometry
Question: Our ophthalmologist renders single-episode tonometry services on her pati... Read more
CCI Update:
Watch for Corneal Ring Segment, Collagen Cross-Linking Bundles
Tip: You can report a Column 2 code with a Column 1 code – but only under cer... Read more
Diagnostic Tests:
Part III: SCODI, FA, Fundus Photography, and Gonioscopy Round Out Your Diagnostic Coding Arsenal
Warning: Don’t get tripped up by tricky bilateral rules. In the last issue of Op... Read more
E/M:
Make Sure Your E/M Claims Aren't Part of the 14.6% Error Rate
NPP claims are part of the problem. Evaluation and management coding and “incid... Read more
Reader Question:
Single Code for Bilateral Pachymetry
Question: I’m trying to submit a claim for 76514 performed on both eyes, but ... Read more
Reader Question:
Beware Medical Records Rules
Question: We discharged a patient due to non-payment, and one week later a new surg... Read more
Reader Question:
Determine PFSH for E/M Choice
Question: I have a surgeon’s note for an office visit that clearly indicates ... Read more
You Be the Coder:
Endophthalmitis
Question: The ICD-10 description for endophthalmitis now says to “use additio... Read more
Diagnostic Tests:
Part II: Refraction, Topography, Visual Fields - Keep Your Diagnostic Test Coding On Point
Follow these expert tips for CPT® 92015, 92025, and 92081-92083. In the last issue... Read more
ICD-10:
H47 Family Holds the ICD-10 Answers for Optic Chiasm, Visual Cortex Disorders
Check detailed codes for side specificity. If you’re in a neuro-ophthalmology pr... Read more
Compliance:
OIG Recovered $3.35 Billion in 2015, Plans Scrutiny of Ophthalmology Services
Place of service errors also continue to be on the agency’s radar screen. Any am... Read more
Compliance:
Get Ahead of Notification Curve for PHI Breach
Avoid stiff penalties that could hurt your practice. With fines ranging from $100 to $... Read more
Reader Question:
Avoid ICD-9 and ICD-10 on 1 CMS-1500 Form
Question: Our physician admitted a patient in September and didn’t discharge ... Read more
Reader Question:
Test EHR Functionality Frequently Post-Implementation
Question: What should our practice do to prevent unintended consequences from elect... Read more
Reader Question:
Don't Take Chart Amendments Lightly
Question: One of our physicians made mistakes on several charts and printed out new... Read more
You Be the Coder:
Focal Laser in Post-op Period
Question: On Sept. 15, the ophthalmologist performed focal laser surgery on the are... Read more